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Pharm II Exam 4 > Antidepressants > Flashcards

Flashcards in Antidepressants Deck (50):
1

Which emerging drug has been found to result in rapid relief of SI?

Ketamine

2

What do we think major depressive disorders result from?

Deficiency of NE or 5-HT

Changes in trophic factors & hormones play a role

3

When NTs bind to a specific receptor, what occurs?

Coupling --> cascade of events

4

NTs are ______ back into nerve cells by reuptake pumps (transporter molecules)

reabsorbed

5

What is the primary MOA of antidepressants?

Inhibit transporter molecules & allow more NT to remain in the synapse

6

Depression is a/w changes in ______ or _______

serotonin

norepinephrine

7

Most antidepressants cause changes in ______

amine signaling

8

What is a/w more severe forms of major depression?

Abnormal HPA axis
Elevated cortisol

9

What are other neuroendocrine factors seen in depression?

Thyroid dysregulation

Estrogen deficiency

Testosterone deficiency

10

Describe the acute phase in the tx of MDD

What is the goal?

Lasts 6-12 wks

Goal = remission

11

Describe the continuation phase in the tx of MDD

What is the goal?

Lasts 4-9 months after remission is achieved

Goal = eliminate residual sx or prevent relapse

12

Describe the maintenance phase in the tx of MDD

What is the goal?

12-36 months

Goal = prevent recurrence

13

Which types of medications are a/w drug-induced depressive sx?

Acne tx
Anticonvulsants
Antimigraines
CV meds
Hormone therapy
Immunologic agents
Smoking cessation

14

What are the different classes of antidepressants?

TCAs
MAO inhibitors
SSRIs, SNRIs
5-HT2
Heterocyclic

15

What are 4 characteristics of antidepressants?

Rapid oral absorption

Tightly bound to plasma proteins

Undergoes hepatic metabolism

Renally cleared

16

Which group of antidepressants can also be used for chronic pain & enuresis?

TCAs

17

What are examples of TCAs?

Amitriptylline (prototype)
Imipramine
Desipramine
Doxepine
Nortriptyline

18

Which drug class is also used to treat Selegiline-Parkinson's disease?

MAOIs

19

What are examples of MAOIs? (3)

Phenelzine
Tranylcypromine
Selegiline

20

What are ADEs/drug interactions of MAOIs?

Combined w/ tyramine & sympathomimetics --> HTN

Combined w/ SSRIs --> serotonin syndrome

Toxicity: hypotension, insomnia

21

What are sx of serotonin syndrome?

Range from mild to lethal & include cognitive, autonomic & somatic effects

22

What foods should be avoided w/ MAOIs?

Cheese
Beer
Soy
Sausage
*All contain high tyramine

23

What drug class does warfarin interact w/?

SSRIs

24

What is an ADE of SSRIs?

Sexual dysfunction

25

Which SSRI is not used in pregnancy? Why?

Paroxetine

Has NE & anticholinergic activity

26

Which SSRI can cause QT prolongation?

Citalopram

Therefore doses > 40mg/day are not recommended

27

When can you increase escitalopram (SSRI) to max daily dose?

After 1 week if needed

28

What is important to know in regards to fluoxetine (SSRI) dosing?

Doses > 20mg/day may be given in a single daily dose or divided BID

29

How much do you titrate paroxetine (SSRI) weekly?

10 mg/day OR

12.5 mg/day

*Depends on max daily dose

30

How much do you titrate sertraline (SSRI) weekly?

25 mg/day

31

What is an ADE common to all antidepressants?

Suicidality

*Monitor behavior changes & mental status

32

What is an ADE of venlafaxine (SNRI)?

HTN

*Dose reductions may be required if sustained HTN occurs

33

Is there a benefit of exceeding 50 mg/day of desvenlafaxine (SNRI)?

No - ADE's are increased & no additional benefit has been shown

34

Are doses exceeding 60 mg/day of duloxetine (SNRI) more efficacious?

No - not shown to provide increased efficacy

35

Besides major depression, what else are 5-HT2 antagonists & 5-HT reuptake inhibitors used for?

Depressed pts w/ anxiety

Depression w/ cognitive difficulties

36

How should daily doses of nefazodone (Mixed 5-HT) be taken?

Divided BID

37

How should daily doses of trazodone (Mixed 5-HT) be taken?

Divided TID

38

What is the highest dose of vilazodone (Mixed 5-HT) that has been assessed?

40 mg/day

39

What are 2 examples of other heterocyclics?

Bupropion (NE & dopamine reuptake inhibitor - NDRI)

Mirtazepine (serotonin & alpha2-receptor antagonist)

40

What is the MOA of other heterocyclics?

Mirtazepine blocks presynaptic alpha2

Buproprion - NET> SERT

41

Besides major depression, what else are other hertocyclics used for?

Smoking cessation (bupropion)

Sedation (mirtazepine)

42

What are ADEs of bupropion?

Lowers seizure threshold

*Seizures are dose-related, & may be increased by predisposing factors (hx of seizures, alcohol withdrawal, head trauma, CNS tumor)

43

What are ADEs of mirtazepine?

Sedation & wt gain

44

How often can you increase the dose of mirtazapine?

No more than every 1-2 wks

45

What is the MOA of folate?

Synthesis of NTs, s/a 5-HT

46

In regards to folate, the task force states that...

augmentation w/ folate is reasonable, but more work is needed to clarify which subgroup of pts may achieve the greatest response

47

What is the MOA of TCAs?

Block reuptake transporters of NE & serotonin

48

What ADEs are common to all SNRIs?

CV changes
Insomnia
Nausea
Serotonin syndrome
Sexual dysfunction

49

What ADE is unique to desvenlafaxine (SNRI)?

Dose-related HLD

50

What ADE is unique to duloxetine (SNRI)?

Orthostatic hypotension